A Case of Gastrinoma Presented Marked Skip Metastasis to the Para-Aortic Lymph Nodes

Masaya Inoue, Tsuyoshi Sano, Kazuaki Shimada, Yoshihiro Sakamoto, Satoshi Nara and Tomoo Kosuge

Department of Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital

We report a case of gastrinoma presented with Zollinger-Ellison syndrome associated with skip metastasis to the paraaortic lymph nodes. A 56-year-old woman with a two-year history of medical treatment for multiple duodenal ulcer and presented with watery diarrhea. Computed tomography (CT) revealed a mass 20 mm in diameter in the head of the pancreas. Hormonal examination showed elevation of serum gastrin level, suggesting gastrinoma. She underwent subtotal stomach-preserving pancreatoduodenectomy with retroperitoneal lymph node clearance due to the paraaortic lymph nodes metastasis confirmed by intraoperative frozen section. A pathological diagnosis for primary pancreatic gastrinoma was made using a positive immunohistochemical staining for gastrin, and showed not regional but skip metastasis to the paraaortic lymph nodes. This case is highlighted a gastrinoma with skip metastasis to the paraaortic lymph nodes that is an extremely rare situation and, to our knowledge, no such previous case has been reported.

Key words
Zollinger-Ellison syndrome, gastrinoma, skip metastasis

Reprint requests
Tsuyoshi Sano Department of Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital
5-1-1 Tsukiji, Chuo-ku, 104-0045 JAPAN

Accepted
May 30, 2007

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